MEDICARE: DR. SAMIR PANCHOLI D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207YS0123X	Facial Plastic Surgery	1308	NV
2	208200000X	Plastic Surgery	1308	NV

General Provider Information

NPI Number	:	1952485179
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAMIR PANCHOLI D.O.

Provider Business Mailing Address
First Line	:	8068 W SAHARA AVE
Second Line	:	SUITE G
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-1973
Country	:	US
Telephone Number	:	702-363-0240
Fax Number	:	702-363-0256

Provider Business Practice Location Address
First Line	:	8068 W SAHARA AVE
Second Line	:	SUITE G
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-1973
Country	:	US
Telephone Number	:	702-363-0240
Fax Number	:	702-363-0256

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	07/08/2007

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